Attacking Heart Disease Is A National Concern

March 03, 1988|By Dr. Jean Mayer and Jeanne Goldberg, R.D.

Have you heard the one about the two researchers studying diet and heart disease? Scientist ``A`` believed that cholesterol had become a household word, well-known to Americans concerned about coronary risk. Scientist ``B``

disagreed.

To settle the dispute they entered the bar at their hotel, where one of them requested ``cholesterol on the rocks.`` Minutes later the waiter returned-minus the drink, of course. He expressed the bartender`s regret that he could not fill the order, but promised to have it in a day or two.

That story made the rounds in the medical world about a dozen years ago. Today the waiter would probably give a different answer. According to nationwide surveys conducted by the National Heart, Lung and Blood Institute in 1983 and 1986, Americans are well-informed about the risks of

cardiovascular disease.

One set of surveys examined the attitudes and practices of physicians likely to be involved in the management of serum cholesterol, including family practitioners, internists and cardiologists. The second set focused on the general public.

Results are encouraging. Physicians, it was found, are increasingly committed to promoting preventive measures for their patients.

In 1983, only 39 percent believed that an elevated blood cholesterol level had a large effect on coronary heart disease. Three years later, that figure had risen to 64 percent-a 25 percent jump. If those who believe it has a moderate effect are also added in, the number climbs to 98 percent of all physicians surveyed.

The percentage of those physicians who believed that a high-fat diet was linked to risk also rose (from 28 to 40 percent), as did the number who strongly agree that the cholesterol levels of American males are too high (41 percent in 1983; 60 percent in 1986). While 79 percent of those surveyed ordered blood-cholesterol work-ups of male patients in 1983, by 1986 that figure had risen to 87 percent. Physicians also report that they are treating more patients whose blood-cholesterol levels are elevated.

Why the shift in those three years between surveys? A landmark study published shortly after the 1983 survey may be part of the reason. The Lipid Research Clinics Coronary Primary Prevention Trial (LRC-CPPT) showed for the first time that reducing serum cholesterol led to fewer heart attacks, both nonfatal and fatal. An NIH Consensus Conference held shortly thereafter spelled out specific objectives for management of serum-cholesterol levels, including the recommendation that adults aim for a target of 200 milligrams

(mg.) per deciliter of blood.

Compared to physicians, the public underwent less of a change of heart. This is because by 1983 Americans already knew so much about the risk factors of heart disease that by the time of the second survey little shift could be expected.

For instance, in the earlier survey the percentage of those who believed that various measures could help prevent heart disease were as follows:

Three years later, the stong belief in the value of lowering serum cholesterol and eating fewer high cholesterol foods rose 8 percent and in the value of eating fewer high fat foods, 6 percent. Other changes were small. When added to those who agree that these measures are moderately effective in preventing heart disease, the tally for these and other measures includes more than 90 percent of those surveyed.

The public also knows how to translate general information into specific behaviors, such as understanding that eating less fat and cholesterol means cutting down on foods such as sausage, bacon and luncheon meats.

The message to all of us is simple: know your cholesterol level. The corollary is obvious: If it is elevated, do something about it. Evidence suggests that collectively we know a lot about what to do.

Putting that knowledge into practice may mean losing weight. It also means eating less fat, especially saturated fat, limiting cholesterol and reducing salt intake. These remain the first steps in a personal offensive to reduce your own risk.